Alfredo Luiz Jácomo

Universidade de São Paulo

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Flávia Emi Akamatsu

Universidade de São Paulo

Flávio Hojaij

Universidade de São Paulo

Mauro Andrade

Universidade de São Paulo

Samir Saleh

Vanderbilt University Medical Center

Ana María Itezerote

Universidade de São Paulo

Carlos Augusto Real Martinez

Universidade São Francisco

Mauro Andrade

Universidade de São Paulo

Walcy Rosólia Teodoro

Universidade de São Paulo

Aldo Junqueira Rodrigues Júnior

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

José Aires Pereira

Universidade São Francisco

Cooperative Institutions

Universidade de São Paulo

171

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

100

Universidade Brasil

Hospital Universitário da Universidade de São Paulo

Hospital Sírio-Libanês

Centro Universitário das Faculdades Metropolitanas Unidas

Universidade Federal de São Paulo

Hospital São Paulo

Instituto do Câncer do Estado de São Paulo

Universidade Estadual de Campinas (UNICAMP)

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Is there something new regarding triceps brachii muscle insertion?

Figshare (2021)

Flávia Emi Akamatsu José Renato Negrão Marcelo Bordalo Rodrigues Ana María Itezerote Samir Saleh

Abstract Purpose: Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. Methods: Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. Results: A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. Conclusion: Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.

10.6084/m9.figshare.14282317

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Long-Term Results of Intraoperative Radiation Therapy for Early Breast Cancer Using a Nondedicated Linear Accelerator

Advances in Radiation Oncology (2023)

Samir Abdallah Hanna José Luiz Barbosa Bevilacqua Alfredo Carlos Simões Dornellas de Barros Felipe Andrade José Roberto Morales Piato

To present the long-term results of intraoperative radiation therapy (IORT) for early breast cancer using a nondedicated linear accelerator.The eligibility criteria were biopsy-proven invasive carcinoma, age ≥40 years, tumor size ≤3 cm, and N0M0. We excluded multifocal lesions and sentinel lymph node involvement. All patients had previously undergone breast magnetic resonance imaging. Breast-conserving surgery with margins and sentinel lymph node evaluation using frozen sections were performed in all cases. If there were no margins or involved sentinel lymph nodes, the patient was transferred from the operative suite to the linear accelerator room, where IORT was delivered (21 Gy).A total of 209 patients who were followed up for ≥1.5 years from 2004 to 2019 were included. The median age was 60.3 years (range, 40-88.6), and the mean pT was 1.3 cm (range, 0.2-4). There were 90.5% pN0 cases (7.2% of micrometastases and 1.9% of macrometastases). Ninety-seven percent of the cases were margin free. The rate of lymphovascular invasion was 10.6%. Twelve patients were negative for hormonal receptors, and 28 patients were HER2 positive. The median Ki-67 index was 29% (range, 0.1-85). Intrinsic subtype stratification was as follows: luminal A, 62.7% (n = 131); luminal B, 19.1% (n = 40); HER2 enriched 13.4% (n = 28); and triple negative, 4.8% (n = 10). Within the median follow-up of 145 months (range, 12.8-187.1), the 5-year, 10-year, and 15-year overall survival rates were 98%, 94.7%, and 88%, respectively. The 5-year, 10-year, and 15-year disease-free rates were 96.3%, 90%, and 75.6%, respectively. The 15-year local recurrence-free rate was 76%. Fifteen local recurrences (7.2%) occurred throughout the follow-up period. The mean time to local recurrence was 145 months (range, 12.8-187.1). As a first event, 3 cases of lymph node recurrence, 3 cases of distant metastasis, and 2 cancer-related deaths were recorded. Tumor size >1 cm, grade III, and lymphovascular invasion were identified as risk factors.Despite approximately 7% of recurrences, we may infer that IORT may still be a reasonable option for selected cases. However, these patients require a longer follow-up as recurrences may occur after 10 years.

Lymphovascular invasion

Breast-conserving surgery

10.1016/j.adro.2023.101233

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A rare pattern of brachial artery variation

The FASEB Journal (2012)

Alfredo Luiz Jácomo Flávia Emi Akamatsu Samir Saleh Mauro Andrade

Introduction Unlike venous system, variations in arterial anatomy are less frequent and most of them affect visceral arteries. In limbs, variations of the brachial artery are the most reported and at least six different patterns have been described so far. The commonest is the superficial brachial artery which lies superficially to the median nerve. Much less prevalent are the high origin of the radial artery (brachioradial artery) or the existence of a doubled brachial artery (accessory brachial artery). We present a previously undescribed pattern of brachial artery variation. Description During dissection of the right upper limb of a 60 year‐old male embalmed cadaver, we found the bifurcation of the brachial artery in the proximal portion of the middle third of the arm. Its medial branch reaches the medial aspect of the arm, posterior to the median nerve. Afterwards, this medial branch redirects laterally and crosses again the median nerve, this time lying anterior to the nerve until it reaches the lateral aspect of the arm. At the elbow level, the medial branch originates the radial artery. The lateral branch of the brachial artery remains lateral to the median nerve and continues as ulnar artery and originates the interosseus artery.

Brachial artery

Ulnar artery

Radial nerve

10.1096/fasebj.26.1_supplement.722.11

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Metabolic Duodenal Switch: The Old Is New Again

Journal of the American College of Surgeons (2017)

Nilton Kawahara Clarissa Alster-Vicente Akemi Koyaishi Alfredo Luiz Jácomo

Duodenal switch

10.1016/j.jamcollsurg.2017.07.674

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Morphometry and frequency of the pyramidalis muscle in adult humans

Revista de Medicina (2018)

Rudolph Octaviano Kogima Pedro Antonio Araújo Simões Lesley Mirian De Paula Santos Raquel Ajub Moysés Flávio Hojaij

The pyramidalis muscle presents variable morphometry and frequency among populations, and the knowledge of such variations may serve as a support for clinical practice and surgical procedures. However, this muscle is little described in the medical literature, and studies of this order have not been performed in the brazilian population. Thus, we dissected 30 cadavers, exposing the pyramidalis and taking photos for posterior measuring in image processing program. We verified frequency - bilaterality, unilaterality and absence - and morphometry - medial border length and width at basis - of the muscle. We verified that there was length symmetry between right and left sides, but no width symmetry. Moreover, there were no statistically significant correlations between the muscle dimensions (length and width) and age, height, weight, nor gender, although, in the present study, men presented longer - but women wider - pyramidalis muscle. Furthermore, the dimensions range of the pyramidalis were bigger in men. Note: it was adopted significance level of 0.05; and two degrees of decimal accuracy. The data obtained was also compared to other studies, revealing that the brazilian population presented an average incidence compared to other populations and that unilaterality was more prevalent and its absence less prevalent than in other populations. Therefore: 1. Due to the muscle´s great variability it’s hard to use it as a reference for incisions; 2. The pyramidalis muscle proved to be very prevalent, enhancing the viability of using it as a graft and as source of stem cells for various purposes.

Decimal

10.11606/issn.1679-9836.v97isuppl.1p7-7

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Metabolic Duodenal Switch: The Old is New again

Surgery for Obesity and Related Diseases (2017)

Nilton Kawahara Akemi Koyaishi Alfredo Luiz Jácomo

Duodenal switch

Biliopancreatic Diversion

Excess weight

10.1016/j.soard.2017.09.119

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Evaluation of oral-motor movements and speech in patients with tetanus of a public service in Brazil

Journal of Oral Rehabilitation (2010)

Laura Davison Mangilli Fernanda Chiarion Sassi Alfredo Luiz Jácomo Cláudia Regina Furquim de Andrade

The characterisation of oral-motor movements and speech of patients with tetanus were investigated to determine the existence of possible signs that are characteristic of this pathology. Thirteen patients clinically diagnosed with tetanus (10 with severe tetanus and three with very severe tetanus) and admitted to an intensive care unit underwent clinical evaluation of oral-motor movements and speech. Statistical analysis indicated significant between-group differences for speech motor functions, suggesting that individuals with very severe tetanus present rigidity as a characteristic interfering in articulatory precision (P = 0·035) and movement rate (P = 0·038). For lip closure, tongue movement, palatal elevation, gag reflex and voice quality, no between-group differences were identified for the specific abnormal characteristics. The observed abnormal results indicate that muscle strength and functional status of the oral-motor system presented by most of the participants of the study did not ensure the necessary integrity for satisfactory performance. The characterisation of the oral myofunctional aspects of patients with tetanus provides medical teams, patients and families with a wider and better description of the clinical situation, giving support to the diagnosis, prognostics and treatment.

10.1111/j.1365-2842.2010.02185.x

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Estudo da drenagem linfatica do m. Vasto lateral da coxa

Anais (1993)

Alfredo Luiz Jácomo Aldo Junqueira Rodrigues Júnior Lucivaldo Nasaré Tapajós Figueira Tarcísio Eloy Pessoa de Barros Filho

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Drenagem linfatica superficial da pele da regiao plantar

Acta Ortopédica Brasileira (1994)

Alfredo Luiz Jácomo Aldo Junqueira Rodrigues Júnior Lucivaldo Nasaré Tapajós Figueira Tarcísio Eloy Pessoa de Barros Filho

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Description of a new experimental model skin flap for studying skin viability in rats

Acta Cirúrgica Brasileira (2014)

Cristina Pires Camargo Nelson Fontana Margarido Eduardo Guandelini Guilherme Alexandre Barrucci Vieira Alfredo Luiz Jácomo

PURPOSE: To describe a new experimental flap for studying skin viability in rats. METHODS: Twenty male Wistar rats weighing between 250-300g were divided into two groups: group A - McFarlane technique, a 4 x 10cm flap was used (McFarlane); and in group B modified McFarlane technique, a 3 x 10cm flap was used. Seven days later, the animals were sacrificed and the area of necrosis was evaluated in both groups. RESULTS: Group A presented necrosis in 3% of the total area of the flap (CI: 0.01-0.05), Group B presented necrosis in 37% of the total area of the flap (CI: 0.29-0.46), (p<0.001). CONCLUSION: The modified McFarlane flap presented a larger area of necrosis and could be an adequate experimental model of skin flap viability.

Skin flap

10.1590/s0102-86502014000300004

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Citations (24)